Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 1

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FIGURE.
Timeline of the RVS. ACR indicates American College of Radiology; AMA, American Medical Association; HCFA, Health Care Financing Administration; HOD, House of Delegates; MedPAC, Medicare Payment Advisory Committee; OBRA, Omnibus Budget Reconciliation Act; RAW, Relativity Assessment Workgroup; DRG, diagnosis-related group; RBRVS, Resource-Based Relative Value Scale. Adapted with permission from Donovan.²

Table 1:

Neuroradiology Milestones—ACGME Report Worksheet^{^a}

Health Care Economics—Systems-Based Practice 1
Level 1	Level 2	Level 3	Level 4	Level 5
Describes the technical and professional components of imaging costs in the subspecialty division	Participates in departmental cost-savings initiatives	Describes billing and coding of subspecialty-specific exams and recognizes and corrects incorrect coding; creates reports that contain the elements necessary to support exam coding	Describes Medicare reimbursement for radiology studies and available bonus payments for physicians	Describes the roles of the ACR and AMA in the valuation and revaluation of CPT codes

Note:—ACR indicates American College of Radiology; AMA, American Medical Association.
↵a Reprinted from The Neuroradiology Milestone Project, The Accreditation Council for Graduate Medical Education and the American Board of Radiology.¹

Table 3:

Three categories of codes found in the CPT codebook

CPT Category	Description
I	FDA approved and common in clinical practice
	Based on peer-reviewed literature
	Referred to RUC for valuation
II	Used to report quality performance initiatives
	Decreased need for records review
	No reimbursement
III	Track new/experimental procedures
	Literature suggests possible future use
	Temporary, by definition

Table 5:

Required content and noncontent attributes

Content Items	Noncontent Items
History (with relevant information)	Clarity/certainty
Technique (list procedures/materials)	Language (anatomic/pathologic/radiologic)
Exam quality (degradation factors)	Standardized format
Description
Comparison
Diagnosis
Differential (when appropriate)
Address clinical question
Recommendations (when appropriate)
Conclusions

Table 6:

Examples of the differences between ICD-9 and ICD-10 codes

Example	ICD-9	ICD-10
Neuroradiology	852.21 Subdural hemorrhage without coma	S06.5X0A Traumatic subdural hemorrhage without loss of consciousness, initial encounter
Musculoskeletal	813.45 Torus fracture of radius (alone)	S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture